Critical Career Review

Career Pathways and Core Competencies in Mental Health Nursing

Introduction

From the extensive literature available it is difficult to determine a succinct definition of a clinical career pathway. For the purposes of this report Jones (1997, p. 2) provides the following constructive definition: A clinical career path programme provides a structure for career development for nurses involved in practice, and advancement in such a structure provides recognition and reward for increasing expertise in front-line work with patients/clients.

Underpinning this definition are several factors:

the respective pathways will define different levels of practice, for example

novice, competent, advanced and expert

the levels of practice incorporate particular performance expectations

the nurse's job description outlines the necessary core competencies required to

perform to expectation, and

the appraisal process through which performance is reviewed and improved or

rewarded.

Essentially, the structure of clinical career pathways is derived from setting criteria to distinguish higher levels of performance from expected competence. The criteria that make up the structure focus on programme content, competency, clinical skills, knowledge base, team roles within the unit, and extra organisational/professional responsibilities2. From a management perspective, structure is intrinsically linked to an organisation. A clinical career pathway cannot exist in isolation of the organisation in which it operates. Herein is an inherent difficulty with CCP structures in UK as the Nursing Council determines the CCP structure for nurses. It is regulated, prescriptive and reliant on adherence to a national set of criteria.

Implementation of an external imposed prescribed structure within an organisation does little for employer commitment to provide a supportive environment that encourages nurses to meet the defined criteria for advancement. In their research Fuller and John (1994, cited in Prebble, 2002, p. 6) found one reason for employer non-compliance was that “company specific norms tend to take precedence”. Furthermore, where employer motivations are not trusted there is also likely to be resistance and distrust in the implementation of such a structure. Jones (1997) asserts the need for the following inclusions into the general structure of a CCP:

adequate job descriptions that have been negotiated between both parties, the organisation and the nurse

professional development for the nurse

performance management

competency assessment

remuneration, retraining, disciplinary action, and

advancement procedures

Jones (ibid) reinforces the importance of having robust systems in place to properly embed a new nurse workforce structure. Jones also maintains that the established system must support and reward the development of clinical expertise and knowledge, as well as more generally recognise and respect the contribution of nurses to health services. While the role of the nurse has historically been subservient to that of the doctor and other health specialists, there have been major shifts in the nursing field in the perception of the nurse's role, from one of subservience to one of genuine value adding. Recognition of such input has made it even more important for the creation of new career pathways with new appraisal processes. However, Hine and Trim (1996) see the above criteria as organisational prerequisites that need to be in place before the establishment of an effective nursing workforce ...